Position Statement 71: Access to Health Care
Policy Position
Mental Health America acknowledges that rising healthcare costs and alarming statistics about the variability in quality and delivery of care are driving vigorous debates about quality improvement, access to care and cost containment. We join many other organizations in our concern for the rate of uninsured people, the statistics about health status - particularly regarding morbidity and mortality for those with serious mental illnesses - and the news that an individual has only a 50 percent chance of getting the minimum standard of care regardless of condition or health care setting.[i] At the same time, Mental Health America represents the experiences and needs of consumers and families who too often endure chronic barriers to accessing high-quality, culturally and linguistically competent, adequately-financed community-based services and supports. We support innovative approaches to increasing access to care and improving the quality of health care delivery. Mental Health America remains dedicated to promoting equitable coverage of mental health services and supports and ensuring that the needs of individuals with mental health conditions are not adversely affected by such proposals.
Background
Proposals to reform the health care system abound at the federal and state levels, offering varied approaches to reorganize and potentially improve the financing, quality and delivery system of health care. Proposals range from universal coverage, which would create a new nationally governed system of healthcare, to insurance market reforms that create new instruments such as health savings accounts (HSAs) or create an individual obligation to secure health insurance. According to the President's New Freedom Commission on Mental Health[ii] and the Surgeon General Report on Mental Health [iii], lack of accessibility to appropriate mental health services and supports is a key factor related to health disparities in people of color. Lack of access and availability of services and supports places a greater burden on racially and ethnically diverse populations than whites. [iv] It is vital that issues relevant to access, scope of coverage, cultural appropriateness, and delivery of mental health treatment and support services be addressed.
Mental Health America is a leading voice for the rights and needs of all consumers with mental health conditions as these proposals are considered. Our advocacy and education initiatives therefore emphasize that healthcare reform should arise from the following principles:
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All people are entitled to comprehensive health care services that are high-quality, culturally and linguistically appropriate, affordable and accessible.
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Any comprehensive proposal for the provision of health care services should include a full continuum of mental health care services ranging from preventative care to long-term care that promotes recovery, total wellness and incorporates cultural practices and beliefs.
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Consumers of mental health services and families of children with mental health conditions should be included in policymaking discussions, including via public forums, in governance and oversight of programs, private contracts, and institutions and in discussions about system assessment and quality improvement.
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To eliminate behavioral health disparities and the resulting burden, policies and practices should incorporate and be responsive to cultural pathways related to problem identification, help-seeking patterns, referrals, diagnosis and treatment preferences.[v]
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All appropriate professional, qualified self-help providers, and programs congruent with individual cultural beliefs furnishing mental health care services that are based on evidence should be eligible for reimbursement. [vi]
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Cost containment mechanisms that include utilization review or a pre-admission approval process should also ensure that necessary services are not denied.
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The cost of a comprehensive health care system, designed to meet the needs of all people should be shared by all people, according to their ability to pay, thereby avoiding a disproportionate burden on any individual or sector within our society.
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Any restructured health care system should strive to reduce administrative expenses and redirect the savings toward enhanced health care and social supports that improve health outcomes.
Call to Action
Mental Health America seeks the enactment of a national plan which is progressively financed and provides access to a comprehensive, culturally and linguistically appropriate array of health care services for all people. Individuals and families should have access to a complete continuum of evidence-based mental health care services, including prevention, early intervention, treatment, and rehabilitation. Specifically, public and private health programs should cover, at a minimum, the services outlined below. Mental Health America believes that these services should neither be limited based on current or previous mental health treatment, nor subject to different cost-sharing requirements, day or lifetime limits[vii]:
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Outpatient psychotherapy, counseling and other forms of talk therapy when provided by a physician, licensed clinical psychologist, psychiatric nurse, social worker or other qualified mental health professional, or when furnished through a licensed community mental health center or clinic. (out-of-pocket costs and co-pays should be comparable to those for visits to other health care providers).
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Care coordination between primary care providers and mental health specialists to ensure focus and optimization of both physical and behavioral aspects of an individual's health.
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Inpatient hospital care and other residential mental health care with provisions which ensure appropriate use and duration of such services.
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Emergency and crisis services, including crisis hotlines, suicide hotlines, crisis counseling, walk-in crisis intervention services, crisis residential treatment services, mobile crisis outreach teams and crisis respite care.
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Psycho-social rehabilitation services, including supported employment, supported housing, clubhouse and other services that focus on individual empowerment and rehabilitation to achieve more independent functioning in the community.
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Access to a full array of medications approved for the treatment of mental health conditions with clinically-appropriate utilization management and not arbitrary restrictions such as per month limits or fail first requirements.[viii]
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Consumer self-help program services and peer support services that are provided by trained and certified peer specialists.
Mental Health America additionally calls for the following reforms within the private and public health care industry:
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Amending the Employee Retirement Income Security Act (ERISA) or the federal tax code to require that the same standards apply to businesses that are "self-insured" as apply to businesses offering state regulated health insurance policies.
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Banning practices, such as medical underwriting and pre-existing condition exclusions, which are used by the private insurance industry to selectively discriminate against various segments of the population, including persons with mental health care needs.
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Developing standards for medical underwriting (until such practice is prohibited) to ensure that the actuarial data used to determine coverage is sound and statistically accurate.
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Prohibiting pre-employment screening by employers to determine potential health care usage and "insurability."
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Providing group health insurance that is "portable" (i.e. not tied to a specific employer) and can be transferred to other employment and non-employment situations.
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Eliminating the differentiation between deductibles for various insured members of a family, for specific services, or for certain conditions.
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Providing clear information for consumers that detail the benefits and restrictions of any health care policy.
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Ensuring adequate reimbursement for providers of health care services and providers who are culturally competent and responsive to the specific needs consumers and families.
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Reducing the amount of each premium dollar that is used for administration and marketing.
Effective Period The Mental Health America Board of Directors approved this policy on March 03, 2007. It will remain in effect for five (5) years and is reviewed as required by the Mental Health America Public Policy Committee. Expiration: March 2012
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[i]Steven M. Asch, M.D., M.P.H., Eve A. Kerr, M.D., M.P.H., Joan Keesey, B.A., John L. Adams, Ph.D., Claude M. Setodji, Ph.D., Shaista Malik, M.D., M.P.H., and Elizabeth A. McGlynn, Ph.D. (2006) Who Is at Greatest Risk for Receiving Poor-Quality Health Care? The New England Journal of Medicine. Volume 354:1147-1156, Number 11.
[ii] New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America. Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD: 2003.
[iii] U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General-Executive Summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.
[iv] Huang, L. (2002). Reflecting on cultural competence: A need for urgency. Focal Point, 16, 4-7.
[v] Bernal, G. & Saez-Santiago, E. (2006). Culturally centered psychosocial interventions. Journal of Community Psychology, 34(2), 121-132.
[vi] See Mental Health America policy P-60 Evidence-based Healthcare, November 2006-2011. http://www.mentalhealthamerica.net/go/position-statements/p-60
[vii] See Mental Health America policy P-35 Mental Health Parity in Health Insurance, September 2006-2011. http://www.mentalhealthamerica.net/go/position-statements/p-35
[viii] See Mental Health America policy P-39 Access to Medications in Public and Private Health Systems, March 2004-2009. http://www.mentalhealthamerica.net/go/position-statements/p-39
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